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DC 7337 · 38 CFR 4.114

Rectum and Anus (Hemorrhoids / Fissures) C&P Exam Prep

To document the current severity of your anorectal condition - including pruritus ani, hemorrhoids (internal or external), anal fissures, fistulas, abscesses, rectal prolapse, sphincter impairment, or stricture - in order to assign a disability rating under 38 CFR 4.114 (DC 7336 and/or DC 7337). The examiner will record your symptoms, treatment history, and physical findings to establish how your condition affects your daily functioning.

Format:
Interview + Physical
Typical duration:
15-30 minutes
DBQ form:
rectum-and-anus (rectum-and-anus)
Examiner:
Gastroenterologist or Physician

What the examiner evaluates

  • Type of anorectal condition (hemorrhoids internal/external, pruritus ani, fissure, fistula, abscess, rectal prolapse, stricture, sphincter impairment)
  • Presence and frequency of bleeding or excoriation
  • Presence, frequency, and reducibility of prolapse
  • Number of thrombosis episodes per year
  • Presence of anemia secondary to persistent bleeding (hemoglobin/hematocrit lab values)
  • Pain during or after defecation
  • Straining during defecation
  • Luminal narrowing or stricture of the rectum or anus
  • Impairment of sphincter control including incontinence
  • Inability to open the anus or expel solid fecal matter
  • Presence of drainage, discharge, or active abscess
  • Current and prior treatments including dietary intervention, medications, procedures, and surgeries
  • Impact on daily activities, occupational functioning, and quality of life
  • Relevant diagnostic test results (CBC, colonoscopy, anoscopy, sigmoidoscopy)

The exam will include a verbal history/interview and a physical anorectal examination. The examiner will ask detailed questions about your symptoms and may perform a digital rectal exam or anoscopy. Bring all relevant medical records, prior treatment notes, and a list of current medications. You have the right to request that the exam be recorded in most states.

Measurements and tests

Hemoglobin and Hematocrit (CBC)

What it measures: Blood counts to identify anemia resulting from persistent rectal or hemorrhoidal bleeding. Critical for achieving the 20% rating under DC 7336.

What to expect: A blood draw or review of recent lab work. The examiner will look for low hemoglobin or hematocrit values consistent with iron-deficiency anemia secondary to chronic blood loss.

Critical thresholds

  • Hemoglobin below normal range (typically <12 g/dL in women, <13.5 g/dL in men) documented alongside persistent bleeding Supports 20% rating under DC 7336 for hemorrhoids with persistent bleeding AND anemia
  • Normal hemoglobin with persistent bleeding but no documented anemia May not support 20% rating; rating would depend on prolapse and thrombosis frequency instead

Tips

  • Bring copies of recent CBC lab results to the exam, especially if they show low hemoglobin or hematocrit
  • Mention if your doctor has discussed iron-deficiency anemia in the context of your rectal bleeding
  • If you have been prescribed iron supplements due to bleeding, report this as it supports anemia finding
  • Request lab work from your treating physician prior to the exam if you have persistent bleeding

Pain considerations: Anemia from blood loss may cause fatigue, shortness of breath, and weakness - clearly communicate these systemic symptoms if they affect your daily functioning.

Thrombosis Episode Frequency Count

What it measures: The number of documented thrombosis (blood clot) episodes per year for hemorrhoids, which directly determines the rating percentage under DC 7336.

What to expect: The examiner will ask you to recall and quantify how many times per year you have experienced a thrombotic episode - characterized by sudden severe anal pain, hard lump at the anus, and possible swelling.

Critical thresholds

  • 3 or more thrombosis episodes per year (internal or external hemorrhoids) Supports 20% rating for continuously prolapsed internal hemorrhoids OR 10% rating for external hemorrhoids with 3+ thrombosis episodes per year under DC 7336
  • 2 or fewer thrombosis episodes per year with prolapsed internal hemorrhoids Supports 10% rating under DC 7336

Tips

  • Keep a written log of thrombosis episodes with approximate dates and severity before your exam
  • Review urgent care or ER visits, telehealth notes, or pharmacy records (e.g., Preparation H, sitz bath supplies) as corroborating evidence
  • Do not underestimate frequency - report all episodes you have experienced over the past 12 months
  • If episodes have worsened recently, note whether frequency has increased year over year

Pain considerations: Thrombosis episodes are typically extremely painful. Accurately describe the severity of pain during each episode, including whether you were unable to sit, work, or perform daily activities during the flare.

Physical Anorectal Examination

What it measures: Direct visualization or palpation of external hemorrhoids, internal hemorrhoids (via anoscopy), anal fissures, fistulas, abscesses, prolapse, sphincter tone, and mucosal excoriation or bleeding.

What to expect: The examiner may perform a visual inspection of the perianal area, a digital rectal examination, and/or anoscopy. You will likely be asked to assume a left lateral decubitus or knee-chest position. The exam assesses current anatomical findings.

Critical thresholds

  • Visible excoriation or active bleeding noted on exam Supports 10% rating under DC 7337 for pruritus ani with bleeding or excoriation
  • Prolapsed hemorrhoids identified - assess whether spontaneously reducible, manually reducible, or irreducible Irreducible or continuously prolapsed hemorrhoids support higher rating consideration under DC 7336
  • Sphincter tone abnormality or impairment identified May support rating for impairment of sphincter control under DC 7332 or as noted in DBQ

Tips

  • Do not use suppositories, creams, or enemas immediately before the exam - this may obscure findings
  • If you are experiencing a flare on exam day, inform the examiner immediately
  • If symptoms are absent on exam day but frequent at other times, clearly communicate this discrepancy to the examiner
  • Inform the examiner if you have had prior anorectal procedures or surgeries and provide dates

Pain considerations: If the physical examination itself causes pain, clearly state your pain level (0-10 scale) during the procedure. Pain on examination supports the documented symptom severity.

Rating criteria by percentage

20%

Internal or external hemorrhoids with persistent bleeding AND anemia; OR continuously prolapsed internal hemorrhoids with three or more episodes per year of thrombosis.

Key symptoms

  • Persistent rectal bleeding requiring medical attention
  • Documented anemia (low hemoglobin/hematocrit) attributable to hemorrhoidal blood loss
  • Continuously prolapsed internal hemorrhoids that cannot be manually or spontaneously reduced
  • Three or more distinct thrombosis episodes per year in continuously prolapsed internal hemorrhoids
  • Significant fatigue, weakness, or shortness of breath secondary to anemia from bleeding

From 38 CFR: Per DC 7336: 'Internal or external hemorrhoids with persistent bleeding and anemia; or continuously prolapsed internal hemorrhoids with three or more episodes per year of thrombosis - 20%.'

10%

Prolapsed internal hemorrhoids with two or fewer episodes per year of thrombosis; OR external hemorrhoids with three or more episodes per year of thrombosis. For DC 7337 (Pruritus Ani): With bleeding or excoriation - 10%.

Key symptoms

  • Internal hemorrhoids that prolapse but reduce spontaneously or manually
  • One to two thrombosis episodes per year in internal hemorrhoids
  • External hemorrhoids with three or more painful thrombosis episodes per year
  • Anal itching (pruritus ani) accompanied by visible bleeding or excoriation of the perianal skin
  • Intermittent rectal discomfort, itching, and mild bleeding without anemia

From 38 CFR: Per DC 7336: 'Prolapsed internal hemorrhoids with two or less episodes per year of thrombosis; or external hemorrhoids with three or more episodes per year of thrombosis - 10%.' Per DC 7337: 'Pruritus ani with bleeding or excoriation - 10%.'

0%

Pruritus ani (anal itching) without bleeding or excoriation - noncompensable under DC 7337. Hemorrhoids that do not meet the thrombosis frequency or prolapse criteria - may also be noncompensable but should still be documented.

Key symptoms

  • Anal itching without any visible bleeding or skin breakdown
  • Hemorrhoids managed entirely by dietary intervention with no prolapse or thrombosis
  • Mild intermittent discomfort without meeting threshold criteria for bleeding, anemia, or thrombosis frequency

From 38 CFR: Per DC 7337: 'Pruritus ani without bleeding or excoriation - 0%.'

Describing your symptoms accurately

Bleeding

How to describe it: Describe the frequency, volume, color, and context of bleeding accurately. Specify whether bleeding occurs only with defecation, spontaneously, or continuously. Note whether blood is bright red on tissue or dripping into the toilet. Mention if it occurs daily, weekly, or with most bowel movements.

Example: On my worst days, I have bright red blood dripping into the toilet after every bowel movement and sometimes experience spontaneous spotting of blood in my underwear throughout the day. This has been happening multiple times a week for the past several months and I have been told by my doctor that my blood counts are low because of the ongoing blood loss.

Examiner listens for: Persistent versus intermittent bleeding; whether bleeding is associated with anemia; frequency and volume of blood loss; whether treatment has been sought; any documented low hemoglobin or hematocrit values.

Avoid: Do not say 'just a little blood on the paper' if the bleeding is frequent or has been discussed with your doctor. Do not minimize bleeding that your physician has already noted in records. Do not fail to mention if you have been diagnosed with or treated for anemia related to this bleeding.

Prolapse

How to describe it: Describe when prolapse occurs (with every bowel movement, with straining, spontaneously), whether the tissue returns on its own (spontaneously reducible), requires you to push it back manually (manually reducible), or remains outside permanently (irreducible). Be specific about how often this happens.

Example: On my worst days, tissue protrudes out of my rectum during and after every bowel movement and I have to manually push it back inside with my fingers. Sometimes it protrudes when I am just walking or standing for long periods. I deal with this almost every day and it causes me significant embarrassment, pain, and difficulty at work.

Examiner listens for: Whether prolapse is continuous versus intermittent; whether it is self-reducing or requires manual reduction; frequency in relation to thrombosis episodes; impact on activities of daily living.

Avoid: Do not describe intermittent prolapse as 'occasional' if it is occurring multiple times per week. Do not fail to mention that you must manually reduce the prolapse if that is the case - this detail is critical to the 10% versus 20% determination.

Thrombosis Episodes

How to describe it: A thrombosis episode is characterized by sudden severe anal pain, a hard tender lump at the anus, and difficulty sitting, walking, or working. Describe each episode clearly: when it started, how long it lasted, how severe the pain was, and whether you sought medical care or used over-the-counter treatment.

Example: During my worst thrombosis flare this past year, I had a hard, extremely painful lump at my anus that made it impossible for me to sit down for four days. The pain was a 9 out of 10. I could not drive to work, sit at my desk, or perform my normal duties. I have had this happen at least four times in the past twelve months.

Examiner listens for: Specific number of distinct thrombosis episodes in the past 12 months; severity and duration of each episode; functional impact; any emergency or urgent care visits associated with episodes.

Avoid: Do not round down the number of thrombosis episodes if you have experienced three or more. Do not describe a multi-day flare as a single episode without clarifying its duration. Do not fail to distinguish between general hemorrhoid discomfort and a true thrombotic episode.

Pruritus Ani (Anal Itching) and Excoriation

How to describe it: Describe the frequency, intensity, and character of the itching. Note whether the skin around the anus has cracked, bled, become raw, or developed visible sores or excoriation. Describe any impact on sleep, concentration, or daily activities.

Example: On my worst days, the itching around my anus is constant and intense enough to wake me up at night. The skin has become raw and cracked, and there is visible bleeding when I wipe. The itching and soreness distract me throughout the day and I have to leave meetings or work tasks to address it.

Examiner listens for: Presence of visible excoriation or bleeding versus itching alone; impact on sleep and quality of life; whether topical treatments have been prescribed; frequency and chronicity of symptoms.

Avoid: Do not say the itching is 'not a big deal' if it disrupts your sleep or daily activities. Do not fail to mention if your doctor has observed excoriation or skin breakdown during examinations. The 10% versus 0% distinction under DC 7337 hinges entirely on whether bleeding or excoriation is present.

Pain During Defecation

How to describe it: Describe pain severity on a 0-10 scale, duration of pain after defecation, and any resulting avoidance behaviors (e.g., holding bowel movements, which worsens constipation and symptoms). Note whether pain has caused you to use stool softeners, laxatives, or dietary modifications.

Example: On my worst days, defecation causes a sharp tearing pain rated 8 out of 10 that persists for one to two hours afterward. I dread going to the bathroom and sometimes avoid it for a full day, which makes the problem worse. The pain has caused me to leave work early and avoid physical activity.

Examiner listens for: Severity and duration of pain with defecation; impact on dietary habits and bowel frequency; avoidance behaviors; use of prescribed pain-relieving treatments; any associated sphincter spasm.

Avoid: Do not minimize procedural pain during defecation if it affects your schedule, diet, or daily routine. Do not fail to mention pain that persists for hours after a bowel movement, as this indicates more significant impairment.

Functional Impact and Daily Life

How to describe it: Connect your anorectal symptoms to specific limitations in work, social functioning, and activities of daily living. Describe any modifications you have made such as dietary changes, avoidance of prolonged sitting, carrying supplies (wipes, pads), or needing restroom access. Include impact on occupational duties.

Example: On my worst days, I cannot sit comfortably for more than 20 minutes at a time, which affects my ability to drive, work at a desk, or attend events. I carry protective pads because of unpredictable discharge and bleeding. I have had to leave work early multiple times due to pain and bleeding, and I avoid social situations out of embarrassment.

Examiner listens for: Specific work-related limitations; frequency of missed work or modified duties; need for assistive measures such as cushions, pads, or frequent restroom access; impact on physical activity, social life, and mental health.

Avoid: Do not give only a clinical description of your symptoms without connecting them to real-life impact. The DBQ specifically asks for functional impact - be prepared to give concrete examples of limitations caused by this condition.

Common mistakes to avoid

Underreporting thrombosis frequency by combining multiple-day flares into one 'episode'

Why: The 10% versus 20% distinction for hemorrhoids under DC 7336 depends critically on whether you have had 3 or more distinct thrombosis episodes per year. Undercounting can cost you the higher rating.

Do this instead: Count each distinct thrombosis event (new hard painful lump, separate from the prior one that resolved) as a separate episode. Keep a written log with approximate dates before your exam.

Impact: 10% vs 20%

Not bringing recent CBC lab results showing low hemoglobin or hematocrit

Why: The 20% rating for hemorrhoids requires both persistent bleeding AND anemia. Without objective lab documentation, the examiner may not be able to check the anemia box on the DBQ even if you report significant bleeding.

Do this instead: Request a recent CBC from your VA or private physician before the exam. Bring the printed results and highlight hemoglobin and hematocrit values. If your doctor has diagnosed iron-deficiency anemia, bring those records as well.

Impact: 20%

Describing pruritus ani symptoms as 'just itching' without mentioning excoriation or bleeding

Why: Under DC 7337, pruritus ani without bleeding or excoriation is rated 0% - noncompensable. The 10% rating requires documented bleeding or excoriation. Veterans often minimize skin breakdown as unimportant.

Do this instead: Explicitly describe any cracking, bleeding, raw skin, or visible skin breakdown around the anus. If your treating physician has noted excoriation in records, bring those notes to the exam.

Impact: 0% vs 10%

Not describing the type and reducibility of prolapse accurately

Why: The difference between a spontaneously reducible, manually reducible, and irreducible (persistent) prolapse directly affects the rating level. Examiners need this detail to correctly complete the DBQ prolapse fields.

Do this instead: Before the exam, clearly establish in your mind whether your prolapse reduces on its own, requires manual reduction, or is permanent. Practice describing this clearly: 'The tissue comes out with every bowel movement and I have to push it back with my fingers.'

Impact: 10% vs 20%

Reporting only how you feel on exam day rather than your typical or worst symptoms

Why: Anorectal conditions fluctuate. If you happen to be in a quiet period on exam day, the examiner's findings may not reflect your actual disability level. VA ratings should reflect the full picture of your condition, including flares.

Do this instead: Per M21-1 guidance, report your worst-day symptoms and typical functioning over the past 12 months. If today is a good day, say so explicitly: 'Today is relatively mild, but typically I experience...' and describe your average and worst symptom days.

Impact: All levels

Failing to mention all treatment modalities, including dietary changes and OTC treatments

Why: The DBQ asks about all treatments including special diet, medications, and procedures. Treatment burden (daily stool softeners, high-fiber diet requirements, sitz baths, prescription creams, rubber band ligation, surgery) demonstrates severity and ongoing management need.

Do this instead: Prepare a complete list of all treatments: fiber supplements, stool softeners, prescribed creams or suppositories, sitz baths, rubber band ligation, sclerotherapy, or surgery. Include dates of procedures and whether symptoms persisted afterward.

Impact: All levels

Not connecting symptoms to functional limitations for the examiner

Why: The DBQ includes a section on functional impact. If you only describe clinical symptoms without explaining how they limit your work, sleep, mobility, or daily activities, the examiner has less documentation to support a meaningful rating.

Do this instead: For every symptom, prepare a real-world impact statement: 'Because of the prolapse, I cannot sit for more than 30 minutes'; 'Because of the bleeding, I carry pads and have had to leave work early.' Connect symptoms to life limitations.

Impact: All levels

Prep checklist

  • critical

    Obtain recent CBC lab results showing hemoglobin and hematocrit values

    Request from your VA primary care or treating gastroenterologist. Results showing low hemoglobin or hematocrit are critical to support the anemia component of the 20% rating for hemorrhoids. Bring printed copies.

    before exam

  • critical

    Create a written log of thrombosis episodes over the past 12 months

    Write down approximate dates and duration of each distinct thrombosis episode (new hard painful lump, severe pain). Include any emergency room, urgent care, or telehealth visits for these episodes. Count carefully - 3 or more per year is a rating threshold.

    before exam

  • critical

    Gather all treatment records: medications, procedures, and surgeries

    Compile a list of all current and past treatments including fiber supplements, stool softeners, sitz baths, prescribed creams or suppositories (e.g., hydrocortisone), rubber band ligation, sclerotherapy, hemorrhoidectomy, or fistulotomy. Include dates.

    before exam

  • critical

    Write down your worst-day symptom descriptions for each symptom category

    Prepare specific descriptions for your worst day of bleeding, prolapse, pain during defecation, anal itching, and functional limitations. Practice saying these descriptions aloud so you can communicate them clearly during the exam.

    before exam

  • critical

    Identify and document the type and reducibility of any prolapse

    Determine whether your prolapse is: spontaneously reducible (goes back in on its own), manually reducible (you must push it back), or irreducible/persistent (stays outside). This distinction directly affects your rating level.

    before exam

  • recommended

    Prepare a functional impact statement connecting symptoms to daily life

    Write down specific examples of how your condition limits sitting, working, driving, exercising, sleeping, or social activities. Include any job modifications, missed work, or workplace accommodations. The DBQ has a dedicated functional impact section.

    before exam

  • recommended

    Collect records showing prior diagnosis dates and service connection history

    Locate any records showing when your condition was first diagnosed, including service treatment records, post-discharge VA records, or private physician notes that document the onset and course of your condition.

    before exam

  • recommended

    Note any secondary or related conditions

    Document any related conditions such as irritable bowel syndrome, Crohn's disease, ulcerative colitis, anal fissures, fistulas, abscesses, or sphincter impairment that may warrant separate evaluation on the same DBQ. Note if any condition was caused or worsened by service or by a service-connected condition.

    before exam

  • optional

    Check your state's law regarding exam recording rights

    In most states, veterans have the right to record their C&P examination. Confirm the rules in your state and bring a recording device if permitted. Notify the examiner at the start of the exam that you intend to record.

    before exam

  • critical

    Do not use suppositories, enemas, or heavy topical creams immediately before the exam

    These can obscure physical findings such as excoriation, external hemorrhoids, or active bleeding that the examiner needs to document. Use only your normal hygiene routine the morning of the exam.

    day of

  • critical

    Bring all printed documentation: lab results, treatment records, and symptom log

    Organize documents in a folder with your most recent CBC on top, followed by treatment records and your written symptom log. Offer them to the examiner at the start of the appointment.

    day of

  • recommended

    Arrive early and note your current symptom status honestly

    If today is a relatively mild day, tell the examiner. If today is a bad day or flare, tell the examiner that too. Either way, clarify that your current presentation may not reflect your typical or worst-case functioning.

    day of

  • recommended

    Wear comfortable, easily removable clothing

    You may be asked to disrobe from the waist down for the physical anorectal examination. Wear comfortable pants or a skirt that is easy to remove. Bring a change of protective undergarment if you experience discharge or bleeding.

    day of

  • critical

    Report your worst-day symptoms - not just how you feel today

    Per M21-1 guidance, the VA rating should reflect the full extent of your disability. If today is a good day, clearly tell the examiner: 'Today is relatively mild. My typical experience is...' and describe your worst and average days in detail.

    during exam

  • critical

    Explicitly state the number of thrombosis episodes in the past 12 months

    If the examiner does not ask, volunteer this number. Say: 'In the past 12 months I have had [number] distinct thrombosis episodes, on approximately these dates.' This is one of the most direct rating thresholds on the DBQ.

    during exam

  • critical

    Describe bleeding as persistent if it occurs with most bowel movements or spontaneously

    If your bleeding is not just occasional but occurs regularly - especially if your doctor has noted it or you have been treated for resulting anemia - use the word 'persistent' and describe the frequency accurately.

    during exam

  • critical

    Describe excoriation or skin breakdown for pruritus ani

    If you have visible cracking, raw skin, or bleeding around the anus related to itching, explicitly describe this to the examiner. The 10% versus 0% rating for pruritus ani depends on whether bleeding or excoriation is present.

    during exam

  • critical

    Clarify the type of prolapse if present

    Tell the examiner clearly: 'The tissue protrudes during bowel movements and [goes back in on its own / I have to push it back manually / it stays outside permanently].' Use plain language - the examiner will document this in the DBQ prolapse fields.

    during exam

  • recommended

    Describe functional limitations with specific examples

    When asked about impact on daily life, give concrete examples: inability to sit for extended periods, need for frequent restroom access, use of protective pads, modified diet requirements, missed work, or social avoidance.

    during exam

  • recommended

    Ask the examiner to note all diagnoses present (hemorrhoids, fissures, pruritus ani, abscess, etc.)

    The DBQ covers multiple anorectal conditions. If you have been diagnosed with more than one condition (e.g., both hemorrhoids and pruritus ani, or a fistula), make sure each is discussed and documented separately.

    during exam

  • recommended

    Write down what was discussed and what the examiner appeared to document

    Immediately after the exam, write down everything you remember: questions asked, your answers, what the physical exam showed, and the examiner's apparent focus. This is important if you need to file a supplemental claim or request a new exam.

    after exam

  • recommended

    Review the DBQ once it is uploaded to your VA records

    After your rating decision, request a copy of the completed DBQ through the VBMS, My HealtheVet, or your VSO. Review it for accuracy, especially the bleeding, thrombosis, prolapse, and anemia fields. If it contains errors, work with your VSO to submit a Notice of Disagreement.

    after exam

  • optional

    If the examiner's opinion seems inadequate, discuss options with a VSO or attorney

    If the DBQ does not accurately reflect your reported symptoms - for example, if the examiner marked 'none of the above' when you reported persistent bleeding - consult a VSO, claims agent, or accredited attorney about requesting a new exam or submitting a nexus letter.

    after exam

Your rights during a C&P exam

  • You have the right to request that your C&P examination be recorded in most states. Notify the examiner at the start of the exam and bring a recording device.
  • You have the right to have a VSO representative, accredited claims agent, or attorney assist you in preparing for your C&P examination.
  • You have the right to request a copy of the completed DBQ after your examination through My HealtheVet, a FOIA request, or your VSO.
  • You have the right to submit your own independent medical opinion (nexus letter) from a private treating physician if you believe the C&P examiner's opinion is inadequate or incorrect.
  • You have the right to request a new C&P examination if the original examination was inadequate, the examiner did not review relevant records, or the DBQ contains factual errors about your reported symptoms.
  • You have the right to submit a Notice of Disagreement (NOD) if you disagree with the rating decision following the C&P exam. You have one year from the date of the rating decision to file.
  • You have the right to be treated with dignity and respect during the physical examination. If you are uncomfortable with any aspect of the examination, you may request a same-sex examiner or to have a support person present.
  • You have the right to have all relevant medical evidence - including private treatment records, lab results, and buddy statements - reviewed by the examiner before the DBQ is completed.
  • The VA has a duty to assist you in obtaining relevant records, including private medical records if you authorize release with VA Form 21-4142.
  • You are not required to exaggerate your symptoms - you are entitled only to accurately and completely describe your condition on your worst days, your average days, and the full impact on your daily functioning.

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This guide covers what to expect for any veteran with this condition. If you have already uploaded your medical records, sign in to generate a packet that maps your specific symptoms to the DBQ fields your examiner will fill out.

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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.